Welcome to Episode 25 of Contain This, brought to you by the Indo-Pacific Centre for Health Security. This week, we're bringing you the highlights from a special joint event held here at the Indo-Pacific Center for Health Security, and the Washington based Center for Strategic and International Studies Commission, on strengthening US Health Security.
We were delighted to host Dr. Anthony Fauci, Chief Medical adviser to the President, and Director of the National Institute of Allergy and Infectious Diseases in the USA, in conversation with Professor Paul Kelly, Australia's Chief Medical Officer.
We hope you enjoy the episode.
For more information about the Indo-Pacific Centre for Health Security, visit our website indopacifichealthsecurity.dfat.gov.au.
Connect with us on Twitter via @CentreHealthSec and @AusAmbRHS
Welcome to Contain This. I'm Stephanie Williams, Australia's Ambassador for Regional Health Security. This week we're bringing you the highlights from a special joint event held here at the Indo Pacific Centre for Health Security, and the Washington-based Center for Strategic and International Studies’ Commission on Strengthening America's Health Security.
We were delighted to host Dr. Anthony Fauci, Chief Medical Adviser to the President and Director of the National Institute of Allergy and Infectious Diseases in the USA, in conversation with Professor Paul Kelly, Australia's Chief Medical Officer. The discussion on how variants are changing the planning for pandemic health strategies to respond to COVID-19 is moderated by Katherine E. Bliss, Senior Fellow with the CSIS Global Health Policy Center.
Katherine E. Bliss
It's a pleasure to join with the Indo-Pacific Centre for Health Security, which is part of the Australia Department of Foreign Affairs and Trade in hosting this discussion today. Now, in many ways, Australia and the United States are really a study in contrast, when it comes to the experience of COVID-19. The number of confirmed cases in Australia has been slightly over 29,000 with fewer than 1000 deaths total in a population of some 25 million people. In the United States, we've had more than 525,000 deaths and more than 29 million confirmed cases of COVID-19, more than the entire Australian population.
So I want to start out with a question from Paul Kelly, from your perspective in Australia, are we seeing a transition in the pandemic and the potential for a shift to seasonal recurring outbreaks as a result of these new variants. And if that's the case, what are the steps that needs to be taken and scaled up to respond to the new variants, right at this moment that vaccines are being distributed?
We started our vaccination program a little later than the US so we're in week three now of our Pfizer rollout and we're just starting an AstraZeneca rollout using local suppliers of the AstraZeneca vaccine. So we're now moving into winter. This will be the 40th Day this year since first of January that we've had zero locally, local locally acquired cases in Australia and we've had no deaths since 2020, less than 20 people in hospitals. So a very different experience in many ways. We can only go one way with this, which is to have more cases eventually, and as we start to open up that will be an issue. In terms of the variants, we've had our own experience here. One of the capacities we've really built in Australia during this pandemic has been our genomic laboratory network and so we're actually sequencing every single case because we're not having many. And we're able to demonstrate what proportion there are of the variants of concern and variants of note or interest. So far we've had 140 cases of the B117 strain, formerly known as the UK strain, and 25 of the South African 1.351 strain, only one of the P1 strains so far. So it's starting to become a large proportion of the cases of the few cases that we have, but mostly they've remained in hotel quarantine. We have had five local outbreaks either in Australia or New Zealand which we've been able to follow very closely. And unlike the outbreaks in other parts of the world with these variants, they've actually been able to be controlled very quickly. So that's an issue that we're sort of looking at now in terms of how we can go forward with the vaccines. You're right, we will have to have a conversation with the Australian public about tolerance of outbreaks because they will be inevitable. I think we have to deal with the way that people feel that is the vaccines are going to change their lives but possibly not as strongly as we first thought with these variants coming in. But it's another learning experience. We've learned to be nimble and flexible and to incorporate new ideas and new concepts and new information when it comes and this is just the latest of those.
Katherine E. Bliss
I think we've all experienced 14 months of adjustment and innovation over this period really trying to think through these new processes. I want to turn to Tony Fauci to ask you in the United States, the number of vaccines distributed daily is accelerating rapidly offering a great deal of hope to a population weary of pandemic era restrictions. But the circulation of the new variants comes at a time when some states are now relaxing the rules and spring weather is on the way. Paul Kelly was just talking about the some of the seasonal changes and some of the changes that he expects to see, we're looking at picnics and barbecues and baseball games and other outdoor gatherings really starting to scale up in the next few weeks and months. So what are the steps that you see needs to be taken to respond to the variants, including those identified in the United Kingdom South Africa and Brazil, as the vaccine programs scale up and does this change how we need to be thinking about this idea of herd immunity, given the new realities.
We went way up, we came down and now the baseline was 40,000 instead of 20,000 cases per day. Then we had the massive surge up, just this past winter in late fall. We were averaging an extraordinary 300,000 to 400,000 cases per day, and 3-4000 deaths per day. That's just a completely different galaxy than what Australia was experiencing. And now as we're coming, way down, we are reaching a point where we're beginning to, if not plateau but the slope of the deflection is starting to maybe go down a little bit more slowly. Which means we might plateau, again, at an unacceptably high level. Why do I go through all those details for you? Because the fundamental tenet of biology is that viruses don't mutate, unless they replicate. And the more spread that you have in the community, the greater chance you're going to have of the initiation of and propagation of variants, and that's what we're seeing in the United States. We have the 117, which will be dominant by the end of March, according to the modellers, we have a low level of the 351 which is the South African one. Now we also have a New York isolate 526, which is spreading rapidly in New York, and a California isolate, which is 427, 429. So we have variants, literally in multiple parts of the country. The question we're seeing is that luckily for us, the vaccines that are being distributed do very well against 117. We know from the experience in South Africa with J and J, that it doesn't do as well, at least J&J vaccine, against moderate disease but does very very well against severe disease, including hospitalizations and deaths. We're trying to find out now, what the impact of the homegrown variants the California, and the new variant is with regard to monoclonal antibodies and vaccines. So, here is the challenge. Are we going to chase each variant in an almost whack-a-mole way, or are we going to try and get a vaccine that has a good degree of cross-protection against several and get the level of virus so low that we don't really have an outbreak proportion? This may require coming back intermittently and boosting either against the prevalent wild type or against the prevalent variant, and in that regard both strategies are being pursued in the United States.
Katherine E. Bliss
So, let's turn to global issues for a moment and this issue of vaccine solidarity or maybe COVID solidarity. Many people as you've just said, Dr Fauci, you know many people are saying if we're not all protected then no one is protected, Australia and the United States, as we've discussed have had very divergent domestic experiences with the pandemic. But they are long standing partners on regional and global health and security issues, including through APEC and the QUAD, the informal Security Forum involving Australia, India, Japan and the US, that may reportedly convene again soon. So, both countries have also indicated support for COVAX, which is the vaccine pillar of the ACT Accelerator to a set up last spring to mobilize global multi-sectoral support for COVID-19 diagnostics, therapeutics and vaccines. Australia has committed funds to COVAX and has made plans to purchase I think additional vaccines to support countries in the Southeast Asia and Pacific region, and the United States has approved $4 billion to GAVI the Vaccine Alliance for procurement and distribution of COVID-19 vaccines to the 92 lower income countries that are part of the Advanced Market Commitment. So I wanted to end by asking each of you to reflect on what you see for the future of cooperation on regional and global health security between the United States and Australia, and how can the two countries work together and with other countries throughout the world to prepare for future pandemics and health emergencies. So Paul Kelly let me, let me turn to you to start.
Professor Paul Kelly
Yeah, thanks Katherine and you're quite right, of course, Australia and the US has a long standing relationship on many levels. In 2020, there was a ministerial agreement in relation to the Indo-Pacific region in particular, and that covers a wide range of cooperation, including training, laboratory support, epidemiology, development of drugs and vaccines and so forth for our shared region in the Pacific and also more broadly in the Indo-Pacific. So, Australia is very, very much committed to exactly what you were mentioning, particularly in our region so Pacific island states are very, very much, front and centre for our support not only in the vaccines themselves but the actual end to end rollout of the vaccines as well as strengthening of surveillance activities, quarantine and the like so that's going to continue. We have supported the COVAX initiative as you've mentioned, a very important component of that vaccine rollout in low and middle income countries and so we'll continue to do that. And we very much welcome looking further and more closely with the US, and what we can do in our region. As I said, we are a connected world and if we ignore that it's not only at the peril of the lower and middle income countries that can't afford the sort of things that we can afford in terms of health care and public health interventions, but also ourselves, not only in the continued production of virus variants. But in terms of threats through incursions. So I think that's a really important component of our work. We're particularly looking at concern with countries to our north in Papua New Guinea and Timor-Leste where there are emerging outbreaks. And so we need to really consider those in particular but we certainly look forward to working with the US on these matters into the future. And I'll finish this by saying that whilst we have throughout this pandemic of course being concentrating on COVID as a specific issue. Everything we've tried to do here in terms of public health strengthening in Australia and elsewhere has had an eye on the larger prize. There's no point in planning only for this pandemic we have to consider what the next pandemic is going to be like, and so those generic strengthening elements are really important.
Katherine E. Bliss
Tony Fauci, what do you see as additional you know research or programmatic policy-oriented collaborations between the United States and Australia that can help prepare for future pandemics and health emergencies, while learning from the COVID-19 pandemic experience?
Dr Anthony Fauci
Well, as Dr Kelly said, the United States and Australia have a long, long history. I've been director of the Institute for now almost 37 years, and I learned on day one that our strongest allies in research, was the top two or three, Australia was clearly one of them. We feel very strongly that this is a global pandemic and requires a global response. Our collaboration, our well established firm collaboration at both the public health and that the basic preclinical and clinical research with Australia is a very strategic partnership, because it will allow both of us, together to be able to implement in the Pacific region, involving so many other countries that Australia deals with literally on a daily, weekly and monthly basis. The alliance between the United States and Australia will help the United States to be value added to the activities that go on in public health in the Pacific region. So I just see a continuation and amplification and an increase in the strong strategic alliance at the basic research, clinical research and public health level with our Australian colleagues, it has been going on for years. It's been very productive, and I hope it will continue to go on, and even amplified.
Katherine E. Bliss
Tony Fauci and Paul Kelly, thank you both for taking the time to join this session today, and thank you to our audience for joining us as well. This afternoon, or this morning early morning, I might add for those of you joining from Australia. Thank you all, and I'd like to thank the staff at CSIS and the Indo-Pacific Centre for Health Security for their support in organizing this meeting. Thank you very much.
Dr Anthony Fauci
Professor Paul Kelly
Thanks Katherine. Thanks Tony.
Dr Anthony Fauci
Thanks, Paul. Thanks Katherine.
Thank you for joining us for this special joint event held by the Indo-Pacific Centre for Health Security and the Washington-based CSIS. Subscribe to Contain This for the latest in global health security trends with a particular focus on the Indo-Pacific region.